1. Medication Reconciliation in Long Term Care

2. Medication Reconciliation, or “Med Rec”, is a formal process of creating a Best Possible Medication History (BPMH)…and using it when writing medication orders

3. Compare the Best Possible Medication History (BPMH) against physician’s admission, readmission/transfer or discharge orders
Identify any discrepancies and alert the physician or other health team members

4. Why is Med Rec Important?
Research suggests medication errors can be decreased by using this process. The Institute for Healthcare Improvement has suggested that as many as 50% of medication errors could be prevented by using an effective Medication Reconciliation Process

5. Why is Med Rec Important?
Ensures accuracy and continuity of medication orders
Reduces potential adverse effects and harm related to changes or loss of information during transfers to other health care settings
Avoids unintentional changes in therapy
Increases safety for resident

6. When Should Med Rec be done?
Transitions of Care such as:
Resident admission
Resident readmission/transfer
Resident discharge

7. Medical Pharmacy’s
new “One-Write” BPMH form
Use it to create a BPMH list for ALL residents on admission or readmission

8. Use multiple (at least 2) sources for information, such as…
resident and/or family
medication vials, wallet cards
previous pharmacy
family physician and specialists
discharge note from hospital
previous MAR
CCAC information
How do I create a BPMH?

9. What do I include on a BPMH?
All current and relevant past prescription medications
Non-prescription medications
Complimentary/alternative and herbal medications
Include indication, dose, dosage form, route, level of patient adherence

10. Remember to ask about: Eye drops, inhalers, patches, sprays Vaccines
Samples or investigational medications
Allergies to medications…including the nature of the “reaction”

11. ≠ Remember… Resident’s ACTUAL Medication Use
Resident’s PRESCRIBED Medications ≠
Use Resident/family interview, CCAC lists, discharge lists or MARs to compare to prescription lists from vials, Dr., pharmacist, medical chart

12. Best Possible Medication History
Resident/Family Interview TIP:
Use Medical Conditions as a trigger to prompt consideration of all medications

13. Best Possible Medication History
Resident/Family Interview TIP:
Use Open-ended questions like:
“How do you take this medication?”

14. Med Rec on Transfer/Discharge
When a resident is transferred to another facility or discharged, a copy of current MAR reconciled with physician’s orders must be provided to receiving facility
MAR